Pharm

PCSK9 Inhibitor

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PCSK9 Inhibitor, Praluent, Alirocumab, Repatha, Evolocumab

  • Mechanism
  1. Monoclonal antibodies (PCSK9 Inhibitor)
  • Indications
  1. Severe familial Hypercholesterolemia (e.g. LDL Cholesterol >190 mg/dl)
  • Background
  1. Available in U.S. as of 2015
  • Preparations
  1. Praluent (Alirocumab)
  2. Repatha (Evolocumab)
  • Efficacy
  1. See disadvantages below
  2. Lower LDL Cholesterol up to 60%
  3. Repatha added to Statin for 2 years prevents one more CV event per 74 treated ($2,000,000 per CV event prevented)
    1. Alkhalil (2017) JAMA 317(16):1690-1691 +PMID: 28444271 [PubMed]
  • Disadvantages
  1. Very expensive agents ($14,000 per year)
    1. Contrast with Statins which cost $250 per year
    2. Statin alone for 5 years prevents one more fatal CV event per 39 treated ($48,000 per fatal CV event prevented)
  2. New, with only short-term data
    1. Unknown longterm safety
    2. Unknown mortality reduction (contrast with proven Statin efficacy)